:: Volume 20, Issue 3 (7-2022) ::
Int J Radiat Res 2022, 20(3): 571-578 Back to browse issues page
Evaluation and analysis of radiation exposure to normal tissues during gamma knife radiosurgery for vestibular schwannoma
J.A. Lee , S.R. Kim , S.H. Yoon , J.S. Kim , H.J. Yang , G.H. Kim
Department of Bio-medical Science, Korea University, Sejong 30019, Korea , yangh@korea.ac.kr
Abstract:   (1828 Views)
Background: A follow-up study of gamma knife radiosurgery has shown that postoperative radiation necrosis, radiation-induced edema, and malignant metastasis may occur. This may be due to secondary radiation exposure, therefore, it becomes necessary to actively reduce exposure to normal organs. Materials and Methods: In this study, the secondary radiation dose to the surrounding normal organs was measured during gamma-knife radiosurgery for vestibular schwannoma disease. Using a human pediatric phantom and a glass dosimeter, a treatment plan was established according to the tumor volume, and then the exposure dose to important normal organs in both eyes, thyroid gland, sternum, and both lungs was measured. Results: According to this study, the cancer occurrence probability due to secondary exposure was calculated to be 7 cases per 100,000 people up to the case of the eye and thyroid gland. Exposure doses of 100.2±0.79 mGy or more were measured in both eyes, which is approximately 1000 times that of a chest X-ray or a flight from Seoul to New York. This indicates exposure through gamma knife surgery. The dose to the thyroid gland was 12.7±0.05 mGy, which exceeds the effective dose of 10 mSv in abdominal computed tomography. Conclusion: By measuring the secondary exposure dose to normal organs during gamma-knife surgery for vestibular schwannoma disease, it was confirmed that the eyes and thyroid gland were exposed dangerously. Therefore, for pediatric patients specifically, a treatment plan that actively reduces secondary exposure is required.
 
 
Keywords: Gamma knife radiosurgery, secondary radiation exposure, secondary cancer, Vestibular schwannoma.
Full-Text [PDF 1778 kb]   (734 Downloads)    
Type of Study: Original Research | Subject: Radiation Biology
References
1. Di Betta E, Fariselli L, Bergantin A, Locatelli F, Del Vecchio A, Broggi S, et al. (2010) Evaluation of the peripheral dose in stereotactic radiotherapy and radiosurgery treatments. Med Phys, 37(7): 3587-3594. [DOI:10.1118/1.3447724] [PMID] []
2. Labby ZE, Barraclough B, Bayliss RA, Besemer AE, Dunkerley DAP and Howard SP (2018) Radiation treatment planning and delivery strategies for a pregnant brain tumor patient. J Appl Clin Med Phys, 19(5): 368-374. [DOI:10.1002/acm2.12262] [PMID] []
3. Choi K and Cho JK (2021) Development and statistical assessment of a radiation safety literacy measurement tool. Int J Radiat Res, 19(1):41-48. [DOI:10.29252/ijrr.19.1.41]
4. Cooksey R, Wu SY, Klesse L, Oden JD, Bland RE, Hodges JC, et al. (2019) Metabolic syndrome is a sequela of radiation exposure in hypothalamic obesity among survivors of childhood brain tumors. J Investig Med, 67(2): 295-302. [DOI:10.1136/jim-2018-000911] [PMID]
5. Hess CB, Thompson HM, Benedict SH, Seibert JA, Wong K, Vaughan AT, et al. (2016) Exposure risks among children undergoing radiation therapy: considerations in the era of image guided radiation therapy. Int J Radiat Oncol Biol Phys, 94(5): 978-992. [DOI:10.1016/j.ijrobp.2015.12.372] [PMID]
6. Wolf A, Naylor K, Tam M, Habibi A, Novotny J, Liščák R, et al. (2019) Risk of radiation-associated intracranial malignancy after stereotactic radiosurgery: a retrospective, multicentre, cohort study. Lancet Oncol, 20(1): 159-164. [DOI:10.1016/S1470-2045(18)30659-4]
7. Kourinou KM, Mazonakis M, Lyraraki E, Stratakis J and Damilakis J (2013) Scattered dose to radiosensitive organs and associated risk for cancer development from head and neck radiotherapy in pediatric patients. Phys Med, 29(6): 650-655. [DOI:10.1016/j.ejmp.2012.08.001] [PMID]
8. Athar BS and Paganetti H (2011) Comparison of second cancer risk due to out-of-field doses from 6-MV IMRT and proton therapy based on 6 pediatric patient treatment plans. Radiother Oncol, 98(1): 87-92. [DOI:10.1016/j.radonc.2010.11.003] [PMID] []
9. Nazemi-Gelyan H, Hasanzadeh H, Makhdumi Y, Abdollahi S, Akbari F, Varshoee-Tabrizi F, et al (2015) Evaluation of organs at risk's dose in external radiotherapy of brain tumors. Iran J Cancer Prev, 8(1): 47-52.
10. Shinya Y, Hasegawa H, Shin M, Sugiyama T, Kawashima M, Takahashi W, et al (2019) Long-term outcomes of stereotactic radiosurgery for vestibular schwannoma associated with neurofibromatosis type 2 in comparison to sporadic schwannoma. Cancers, 11(10): 1498. [DOI:10.3390/cancers11101498] [PMID] []
11. O'Connor MK (2017) Risk of low-dose radiation and the BEIR VII report: A critical review of what it does and doesn't say. Phys Med, 43: 153-158. [DOI:10.1016/j.ejmp.2017.07.016] [PMID]
12. Castinetti F, Brue T, Morange I, Carron R and Régis J (2017) Gamma Knife radiosurgery for hypothalamic hamartoma preserves endocrine functions. Epilepsia, 58(2): 72-76. [DOI:10.1111/epi.13760] [PMID]
13. Zeverino M, Jaccard M, Patin D, Ryckx N, Marguet M, Tuleasca C, et al. (2017) Commissioning of the Leksell gamma Knife® Icon™. Med Phys, 44(2): 355-363. [DOI:10.1002/mp.12052] [PMID]
14. Ei-Shehaby AMN, Reda WA, Abdel Karim KM, Emad Eldin RM and Nabeel AM (2017) Gamma knife radiosurgery for cerebellopontine angle epidermoid tumors. Surg Neurol Int, 8: 258. [DOI:10.4103/sni.sni_206_17] [PMID] []
15. Modorati GM, Dagan R, Mikkelsen LH, Andreasen S, Ferlito A and Bandello F (2020) Gamma knife radiosurgery for uveal melanoma: a retrospective review of clinical complications in a tertiary referral center. Ocul Oncol Pathol, 6(2): 115-122. [DOI:10.1159/000501971] [PMID] []
16. ICRP Publication 103, The 2007 Recommendations of the International Commission on Radiological Protection. Publication 103-Annals of the ICRP 37:(2-4)-Free_extract.pdf
17. Asher AL, Burri SH, Wiggins WF, Kelly RP, Boltes MO, Mehrlich M, et al. (2014) A new treatment paradigm: neoadjuvant radiosurgery before surgical resection of brain metastases with analysis of local tumor recurrence. Int J Radiat Oncol Biol Phys, 88(4): 899-906. [DOI:10.1016/j.ijrobp.2013.12.013] [PMID]
18. ICRP Publication 135, Diagnostic reference levels in medical imaging. ICRP Publication 46, 1 2017, [DOI:10.1177/0146645317717209] [PMID]
19. Chun SM, Lim YJ, Leem W, Kim TS, Rhee BA (2001) Gamma knife radiosurgery for low grade glioma - long-term follow-up results. J Korean Neurosurg Soc, 30(2): 273-280.
20. Paddick I, Cameron A, Dimitriadis A (2021) Extracranial dose and the risk of radiation-induced malignancy after intracranial stereotactic radiosurgery: is it time to establish a therapeutic reference level?. Acta Neurochir (Wien), 163(4): 971-979. [DOI:10.1007/s00701-020-04664-4] [PMID] []
21. Fallows P, Wright G, Harrold N, Bownes P (2018) A comparison of the convolution and TMR10 treatment planning algorithms for Gamma Knife® radiosurgery. J Radiosurg SBRT, 5(2): 157-167.
22. Menzel HG and Harrison J (2012) Effective dose: a radiation protection quantity. Ann ICRP, 41(3-4): 117-123. [DOI:10.1016/j.icrp.2012.06.022] [PMID]
23. Ha MN (2011) Radiation Exposure and Cancer. J Clin Otolaryngol Head Neck Surg, 22(2): 275-281. [DOI:10.35420/jcohns.2011.22.2.275]
24. Carinou E, Ginjaume M, O'Connor U, Kopec R and Sans Merce MS (2014) Sta tus of eye lens radiation dose monitoring in European hospitals. J Radiol Prot, 34(4): 729-739. [DOI:10.1088/0952-4746/34/4/729] [PMID]
25. Boal TJ, Pinak M (2015) Dose limits to the lens of the eye: International Basic Safety Standards and related guidance. Annals of the ICRP, 44(1): 112-117. [DOI:10.1177/0146645314562321] [PMID]
26. Dauer LT, Ainsbury EA, Dynlacht J, Hoel D, Klein BEK, Mayer D, et al. (2017) Guidance on radiation dose limits for the lens of the eye: overview of the recommendations in NCRP Commentary No. 26. Int J Radiat Biol, 93(10): 1015-1023. [DOI:10.1080/09553002.2017.1304669] [PMID]
27. Elmtalab S and Abedi I (2021) Investigating the out-of-field doses and estimating the risk of secondary thyroid cancer in high-grade gliomas radiation therapy with modulated intensity and 3D-conformal: a phantom study. Int J Radiat Res 19(3): 569-574. [DOI:10.52547/ijrr.19.3.569]
28. Iglesias ML, Schmidt A, Ghuzlan AA, Lacroix L, Vathaire F, Chevillard S, et al. (2017) Radiation exposure and thyroid cancer: a review. Arch Endocrinol Metab, 61(2): 180-187. [DOI:10.1590/2359-3997000000257] [PMID] []
29. Koo E, Henderson MA, Dwyer M, Skandarajah AR, et al. (2020) Radiation-Associated Thyroid Cancer Surveillance and Management in a Cohort of Late Effects Patients. World J Surg, 44: 3028-3035. [DOI:10.1007/s00268-020-05547-6] [PMID]
30. Taylor AJ, Croft AP, Palace AM, Winter DL, Reulen RC, Stiller CA, Stevens MC, Hawkins MM, et al. (2009) Risk of thyroid cancer in survivors of childhood cancer: Results from the British Childhood Cancer Survivor Study. Int J Cancer 125: 2400-2405. [DOI:10.1002/ijc.24581] [PMID]
31. Rampinelli C, Marco P, Origgi D, Maisonneuve P, Casiraghi M, Veronesi G, Spaggiari L, Bellomi M, et al. (2017) Exposure to low dose computed tomography for lung cancer screening and risk of cancer: secondary analysis of trial data and risk-benefit analysis. The bmj 356-347. [DOI:10.1136/bmj.j347] [PMID] []
32. Higuchi Y, Yamamoto M, Serizawa T, Aiyama H, Sato Y and Barfod BE (2018) Modern management for brain metastasis patients using stereotactic radiosurgery: literature review and the authors' gamma knife treatment experiences. Cancer Manag Res, 10: 1889-1899. [DOI:10.2147/CMAR.S116718] [PMID] []

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